Healthy debate is needed to tackle Europe’s ills

The priorities of EU health policy must be kept focused on delivering genuine benefits, despite the many competing demands, says Linda McAvan

The European Parliament is currently discussing the priorities for the next EU health action programme. There is pressure for EU action across a range of areas. But the EU has limited powers and resources in the field of health. It should therefore concentrate on areas where it can make a real difference and add value. Three main areas spring to mind: trans-border health threats, patient/health mobility issues and co-operation/exchange of good practice between health services.

In the first area, we are already facing a major trans-border health threat, a flu pandemic. If a pandemic happens and the EU fails to act effectively in what is clearly a trans-border issue, the public will wonder what EU health policy is all about. But here there are problems of legal competence. The World Health Organization (WHO) has suggested, for example, that the EU organise joint stockpiling of antivirals and co-ordinated orders to increase manufacturing capability. But the Commission lacks competence in this area. It can, for example, stockpile animal vaccines but not human vaccines. The competence issue would have been partly addressed in the draft EU constitution, but in the meantime we must get more clarity about what we want the EU to do and equip it with the necessary resources to do it. One task of the new health programme must be to establish clear and effective mechanisms in this area.

The second one – patient mobility – is an obvious area for more effective EU action. There are different strands to patient mobility. One is to ensure that the new EU Health Card which replaces the old E111 works properly and that citizens fully understand their entitlements. As an MEP I receive dozens of cases from people who incur costs because they are not properly informed about their rights. A second aspect is the much more complex area of patient mobility – the E112 right to planned treatment abroad. More and more EU citizens are now seeking treatment for a range of conditions in another member state. New ideas such as European centres of reference for certain health specialities are being considered. But there are no clear rules governing such mobility. In the absence of clear EU rules, European judges and not elected politicians are writing the rules as they deal with individual complaints. My colleague John Bowis drafted an excellent report for the Parliament last year which sets out a number of options on patient mobility. Commissioner Markos Kyprianou has said that once we have clarity on whether the health sector is included or excluded from the services directive, the Commission will bring forward proposals. They will be very welcome.

The third area is co-operation/ exchange of good practice between national health systems. It is in this area where MEPs receive intense lobbying as organisations dealing with different diseases/conditions push for EU support for their work on different diseases equally deserving of investment. But what we have to bear in mind here is that there is only so much the EU can do. We cannot simply ask the Commission to collect data on different conditions and health determinants without any clear view of how that data can be used to make a difference on the ground. In other words, any action paid for from the EU budget must add value to the work of member states and be part of a clear strategy for action.

Keeping a sharp focus to EU health policy will not be easy. There are over 200 amendments tabled for committee on the health action programme. There are many competing demands. But the more focus we have and the more apparent is the added value from EU-action on public health, the easier it will be to convince the Council and indeed our own MEP budget colleagues to invest proper resources. The public, too, will see the real benefit of EU-level action – and you never know, an effective EU health policy might be just what is needed to convince a sceptical public that the EU can deliver real benefits on issues which matter most to them.

UK Socialist MEP Linda McAvan is a member of the European Parliament’s committee on the environment, public health and food safety.

The EU needs to focus its public health priorities on the Roma population, cancer and mental health problems, argues Anna Zaborska

The first concern for the EU, when it sets out its public health priorities, should be the generally poor health status of the Roma population and its inadequate access to healthcare.

Existing studies on Roma in both Eastern and Western Europe create a picture of higher rates of illness, lower life expectancy and higher infant mortality than the population at large. According to a 2001 study from the Open Society Institute, the infant mortality rate for Roma in Bulgaria is six times greater and in Italy almost three times greater than the wider population. In Hungary and Ireland, it is double the national average.

Low rates of vaccination among Roma are evident across Europe. Tuberculosis breeds in overcrowded houses that have no heat in the winter and Roma children are disproportionately affected by polio, diphtheria and meningitis. High rates of smoking among teens and adults, stress or mental ill-health and chronic diseases like heart and asthmatic ailments are common problems for which they do not easily find help. There is little knowledge about proper nutrition and a lack of the means to secure it.

While Roma women generally exhibit high fertility rates and begin childbearing at a young age, they are less likely to have access to preventive sexual and reproductive health information and care. A number of attitudes and practices among the Roma are specifically detrimental to women’s sexual and reproductive health. First among them is their apparently poor understanding of the value of preventive screenings or of what constitutes a serious health risk or problem.

The physical, economic and information-based barriers to healthcare that many Roma confront result from the complex effects of poverty, discrimination and unfamiliarity with health services.

The second priority should be breast cancer. The facts about the breast cancer in the EU are alarming: every two and a half minutes a woman in the EU is diagnosed with breast cancer and every six and a half minutes a woman dies from the disease. The incidence rate in Europe is increasing every year.

The breast cancer resolution, adopted by Parliament in June 2003, sets a target of reducing breast cancer mortality by 25% by 2008 and reducing the disparities in five-year-survival rates across Europe from 16% to 5% over the same time period. It also deals with issues of screening, patient rights, treatment and training. It calls on the member states to provide screening every two years for all women between 50 and 69 and lays down minimum quality standards, including monitoring of image quality and radiation doses. It sets four weeks as the maximum time any woman should have to wait from diagnosis to the start of treatment and five working days as the maximum time it should take for a woman to be told the results of any clinical examination or screening. The European Parliament asked member states to monitor their performance and to give their first reports in 2006.

The third priority should be mental illness, which affects 27% of European adults and is responsible for the majority of the annual 58,000 deaths by suicide. Depression and anxiety disorders are the most common mental problems experienced and studies have estimated that by 2020 depression will be the highest ranking cause of disease in the developed world.

Mental health problems can have a significant influence on the economic and social welfare of society. They cost the EU 3-4% of gross domestic product through lost productivity and additional burdens on health, education and justice.

Mental health has been swept under the carpet for too long. The Commission, which in October 2005 adopted a Green Paper on mental health, is determined to raise awareness of this problem and to work towards improving the mental health of the EU population.